The Singapore Family Physician

Back to issue Vol 39 No. 3 - Emergency Medicine

Improving Primary Care Management of Time Sensitive Emergencies

Malcolm Mahadevan
Kanwar Sudhir Lather
The Singapore Family Physician Vol 39 No 3 - Emergency Medicine
14 - 19
1 October 2013
Ischemic heart disease, pneumonia, cerebrovascular accidents and chronic obstructive pulmonary disease rank among the top 10 causes of hospitalisation in Singapore 1. For optimum patient outcomes, acute presentations of each of these spectrum of diseases requires a continuum of care involving crucial steps at primary healthcare, pre-hospital transport, emergency care at the emergency department, hospitalisation and sometimes, rehabilitation at step-down facilities. For patients with suspected ACS, a resting 12-lead electrocardiogram (ECG) should be obtained as soon as possible: do not exclude acute coronary syndrome (ACS) with a normal resting 12-lead ECG; administer a loading dose of 300mg aspirin, preferably chewed; do not offer other antiplatelet agents in primary care; if aspirin is given before arrival at hospital, send a written record with the patient; immediate assessment using a standardised tool (CPSS, or FAST, or LAPSS) and then transfer by ambulance is indicated for patients with new or developing stroke-like symptoms. For patients with suspected stroke, attempt to ascertain exact time of onset of stroke - when the patient was last seen at his or her neurologic baseline, rather than the time at which the symptoms were first noticed; therapeutic window for thrombolysis is noted (3 hours for intravenous tPA and 6 hours for intra-arterial tPA). For patients presenting with acute onset dyspnea, assess emergently for signs and symptoms suggestive of airway obstruction; administer high flow oxygen in sitting position/ position of comfort; without delaying transfer, obtain CXR, ECG, capillary blood glucose.